Karolinska Institutet Stockholm University Royal Institute of Technology Stockholm School of Economics

Last (family) Name:

First (given) Name:

Gender:      Female Male

Date of Birth:

Nationality:

Address in home country   ( residence or institution ):

Current Email:

Current Phone:

Current Fax:

Are you (applicant) in Sweden now? Yes No

Accompanying spouse/partner? Yes No

Accompanying children? Yes No

Contact person:

Name of contact person and address of host institution/department in Stockholm:

Email Address:

Phone:

Fax:

Rent to be paid by: Applicant Department

Application sent by: Applicant Department

Required Letter of invitation/acceptance/affiliation from host department to be submitted by: Email Fax Regular Mail

Accommodation wanted from:

Accommodation wanted until:

Other information: